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SUMMER 2016 A Special Publication from The Everett Clinic Heart Failure Matters Medications Commonly Used to Treat Heart Failure H eart failure medications can help you feel better and live longer. The list below includes some of the more common medications used to treat heart failure. Your provider will determine the best medication plan for you. It is very important to take your medications on time, every single day. If you have any questions or concerns about your medications, be sure to discuss them with your provider. Remember: Do not take over-the-counter medications without your provider’s knowledge. ACE Inhibitors Beta Blockers Such as: lisinopril, enalapril, ramipril, benazepril Such as: carvedilol, metoprolol succinate ACE inhibitors (angiotensin converting enzyme inhibitors) are the cornerstone of heart failure drug therapy. They slow the progression of heart failure. They are a type of vasodilator. ACE inhibitors can sometimes cause a dry cough, in which case an ARB (angiotension II receptor blocker) may be preferred. Some examples of ARBs include losartan and valsartan. Diuretics Such as: furosemide, bumetanide, spironolactone, hydrochlorothiazide, chlorthalidone People with heart failure often develop swelling (or edema) in the legs and fluid in the lungs. A diuretic (also called a water pill) helps the body get rid of the excess fluid. This helps to relieve the heart’s workload, since there is less fluid to pump throughout the body. Many people find it best to take diuretics in the morning so trips to the bathroom happen during the day. Taking diuretics in the evening often results in interrupted sleep. The heart tries to compensate for its weakened pumping action by beating faster, which puts more strain on it. Beta blockers reduce the heart’s tendency to beat faster. This allows the heart to maintain a slower rate and lowers blood pressure. Vasodilators Such as: isosorbide dinitrate, hydralazine, nitrates Vasodilators relax and expand blood vessels. This makes it easier for the heart to pump blood throughout the body. These medicines are sometimes used in people who cannot take an ACE inhibitor, to relieve symptoms and improve their tolerance for exercise. Nitroglycerin tablets are a type of vasodilator prescribed to ease chest pain. Digitalis Preparations Such as: digoxin Digoxin helps the heart pump with more force. This can help reduce some of the symptoms of heart failure, especially when the patient isn’t responding to ACE inhibitors and diuretics. It also slows a type of irregular heartbeat (called atrial fibrillation) that is present in some people with heart failure. For digoxin to be effective, patients must take the right amount. This means they will probably have regular blood tests to check their digoxin level. Potassium Potassium helps control heart rhythm and is essential for the normal work of the nervous system and muscles. It’s important to have just the right amount of potassium in the body, especially for the heart. The kidneys control the amount of potassium in the bloodstream and eliminate any excess through the urine. Since most diuretics remove potassium from the body, heart failure patients who use them are at risk of low potassium. Some patients need to take potassium supplements. Sometimes all they need to do is eat foods high in potassium, such as bananas. Spironolactone is a type of diuretic that helps the body retain potassium. If you are taking this medication, you usually should not be taking a potassium supplement. Patients will need to have regular blood tests to check potassium level and kidney function. Heart Failure Self-Management Tool RN/MD Phone Number: _______________________________________ Green Zone: ALL CLEAR ■■ No shortness of breath Green Zone Means: ■■ No swelling ■■ Your symptoms are under control ■■ No weight gain ■■ No chest pain ■■ No decrease in your ability to maintain your activity level Your Morning Weight: ■■ Continue taking medications as ordered ■■ Follow low salt diet ■■ Keep all physician appointments ■■ Continue to monitor weight daily Yellow Zone: CAUTION When to Call Your Doctor If you have any of the following signs or symptoms: Many problems with heart failure, when addressed soon enough, can be treated at home. Monitor your symptoms, ability to engage in activity and daily weight. Call to report any changes to your provider. ■■ Increased cough Sometimes it can be hard to know when to call. To help you understand your symptoms and what to do about them, we are providing a Heart Failure Self-Management Tool. Many people find it helpful to keep it in a visible spot (such as the refrigerator) to refer to when needed. Please discuss the best plan for you with your provider. ■■ Chest pain ■■ Increased weight gain of 2-3 pounds in a day or 5 pounds in a week. ■■ Increased swelling ■■ Decreased appetite or just feeling generally poor ■■ Occasional shortness of breath at rest or increased shortness of breath with activity ■■ Increase in the number of pillows needed to sleep or you need to sleep in a chair Red Zone: DANGER ■■ Your symptoms may indicate that you need an adjustment of your medications ■■ Many of these problems can be dealt with by your nurse and physician. If you ignore them and they go untreated, they may cause you to be admitted to the hospital. ■■ Contact RN/MD regarding weight or symptom changes ■■ Unrelieved shortness of breath Red Zone Means: ■■ Unrelieved chest pain ■■ You need to be evaluated by a physician right away ■■ Wheezing or chest tightness at rest You are receiving these materials as a part of your enrollment in The Everett Clinic’s Heart Failure Disease Management program. Participation is limited to patients in select health plans. The content is designed to reinforce, not replace, information or instructions given to you by your healthcare provider. If you have questions about the Heart Failure Disease Management Program, or prefer to opt out, call 425-317-4654. 3901 Hoyt Avenue ■ Everett, WA 98201 everettclinic.com Yellow Zone Means: ■■ Dial 911